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Therapies

aromatherapy

 

What Is It?
How Does It Work?
What You Can Expect

Health Benefits
How To Choose a Practitioner

Cautions

References
Evidence Based Rating Scale

What Is It?

Aromatherapy is the use of volatile oils, extracted from plants, trees, and herbs, for therapeutic purposes. Although aromatic plant oils have been used to treat various conditions for thousands of years, the term aromatherapy wasn't coined until 1928, when Rene-Maurice Gattefossé, a French chemist first used it. Gattefossé had earlier witnessed the curative capabilities of oil from a plant when he accidentally burned his arm and plunged it into the nearest liquid which happened to be a container of lavender oil. The burn healed quickly without forming a scar. In 1937, he published Aromathérapie: Les Huiles Essentielles Hormones Végétales, which was later translated into English as Gattefossé's Aromatherapy. The book is still in print and is widely read. Marguerite Maury, who built on Gattefossé's work in the 1950s, is credited with developing aromatherapy as a holistic therapy. She was also the first to tailor specific oils to an individual's health needs.(1)

Today aromatherapy utilizes approximately four different types of volatile plant oils singly and in combination:

  • Essential oils. The term "essential oils" is often used generally to include all four types but is actually the most well-known of the aromatherapy plant oils. Essential oils are usually distilled from the plant using steam or water. These "oils" are not really oily-feeling but are usually clear and watery in consistency. They are concentrated and must be diluted if they are to be used topically. Essential oils should not be confused with perfume or fragrance oils, which in modern times are artificially created.

  • Absolutes. These oils are extracted from the plant using chemical solvents which are subsequently removed at the end of the process. This method is often used when the distillation method extracts too little oil or harms the oil during extraction process. Absolutes are more concentrated than essential oils and sometimes may contain a trace amount of the chemical solvent.

  • Carbon dioxide (CO2) extracts. In this method, carbon dioxide gas is pressurized until it becomes a liquid. Liquid CO2 acts as a solvent on the plant and the plant's oil is dissolved in the CO2. When the carbon dioxide is returned to its natural pressure and gaseous state, it evaporates leaving behind the plant oil. CO2 extracts are thicker than essential oils, smell more like the plant and are said to contain additional plant components that are not in essential oils.

  • Hydrosols. A hydrosol is the fragrant water that remains after essential oils have been distilled by steam or water. Hydrosols are gentler than essential oils, water-soluble and can be used directly on the skin without dilution.

Generally, essential oils are helpful for treating stress and stress-related ailments, for invigorating the body, and for promoting general well-being. The oils are used in a variety of ways: they can be mixed with carrier oil (such as a vegetable oil) and applied to the skin during a massage; they may be inhaled; or they can be added to bathwater. Aromatherapy can be done at home by buying the individual oils (they're commonly found at health-food stores and pharmacies) or by visiting a trained aromatherapist, who will probably mix a blend of oils customized especially for each patient and specific condition.

How Does It Work?

A considerable body of research shows that smell, the most acute of our senses, has a powerful influence on our bodies and minds. The scents from essential oils are believed to activate olfactory nerve cells in the nasal cavity, which then send impulses to the limbic system, the area of the brain associated with emotions and memory. (2)

Proponents of aromatherapy believe that the aromatic oils work both emotionally and physically. Emotionally, they may make you feel better by evoking a pleasant memory (the smell of lemons might remind you of a cake a favorite aunt once made, for example). Indeed, numerous studies have shown that smell memory may be more powerful than visual or auditory memory, maturing at an earlier age and lasting longer. (3) Physically, they may help to relieve certain conditions by stimulating the immune, circulatory, or nervous systems.

Aromatherapists stress that only pure, natural, unadulterated essential oils have true medicinal properties. Perfumes, shampoos, and bath oils scented with herbs may smell wonderful, but they are not intended to be therapeutic.

What You Can Expect

Aromatherapy can be a very useful addition to many treatment plans, but it is seldom the primary mode of therapy. Therefore, a consultation with an aromatherapist will usually take place in the context of other medical treatment. The practitioner may also be a massage therapist an herbalist, or use it as a component of another therapy such as Ayurveda. Aromatherapy is also often practiced at home, because the essential oils are easy and pleasant to use. If a person seeks out a professional, the therapist will want to know the general medical history, the level of stress in their life, and the reasons for seeking treatment. Then the patient and therapist will work together to choose the oil or oils that will most effectively address the concern.

Women who are pregnant or thinking about becoming pregnant should tell the aromatherapist because there are certain oils that should be avoided (see "Cautions" below). The therapist also needs to know if a patient is using any homeopathic remedies, because the oils' strong smells can offset the effects of some homeopathic treatments. Because reactions to smells can be idiosyncratic, it's important that individuals let the aromatherapist know if they can't stand the smell of oranges or if the scent of pine brings back harrowing memories of summer camp.

Whether  treatment takes place in a practitioner's office or  at home, the benefits of aromatherapy can be obtained in a number of ways:

  • By direct application of the oils to the skin. Massage with aromatherapy oils allows the substances to be readily absorbed into the skin. To make aromatherapy massage oil, simply add a few drops of an essential oil to a small amount of unscented carrier oil, such as sweet almond oil or safflower oil. Certain oils, such as rosemary, are also used topically to help soothe joint and muscle pain. Always avoid the eyes when applying essential oils to the skin.

  • By inhaling the scents. Breathing in the intense aromas of essential oils is often recommended for easing congestion due to colds, flu, or chronic sinusitis or bronchitis. For this purpose, an aromatherapist might suggest filling a basin with steaming water, adding a few drops of eucalyptus or pine oil, and breathing in the fragrant fumes. Essential oils can also be inhaled by sprinkling a few drops on a handkerchief and breathing in the fumes (keeping eyes closed), or by simply removing the cap from the bottle and taking in the scent. Aromatherapy inhalers are also widely marketed. E.g. one brand advertises that its ingredients include peppermint for increasing alertness, rosemary for strengthening the mind, and cedarwood to help focus thoughts. For a less intense but still pleasant effect, some people like to use a special electrical device called a diffuser to disperse microparticles of an essential oil throughout a room.  

  • By adding the oils to a bath. Adding eight to 15 drops of an essential oil to a bath after the water has finished running creates a relaxing atmosphere and allows the oil to seep into the skin. It's best not to use soap in an aromatherapy bath, because it may interfere with the absorption of the oil.

Health Benefits

There is no evidence in the medical literature that aromatherapy on its own can prevent or heal disease. However, several studies have shown its ability to promote recovery in certain conditions and to reduce stress. Researchers at New York's Memorial Sloan-Kettering Cancer Center recently found that the vanilla-like smell of heliotropin helped patients relax while they were undergoing MRI scans. (3) A study of patients who had undergone heart surgery found that those who received a foot massage with neroli (bitter orange blossom) ) oil were less anxious than those who received the same massage with plain oil. (4) And in a controlled trial in Scotland, researchers reported that a few dabs of diluted thyme, rosemary, lavender, and cedar oils, rubbed daily into the scalp for seven months, proved highly effective, and safe, in treating alopecia areata, a stress-related form of hair loss. (5)

Despite little scientific research, European physicians and aromatherapists frequently prescribe certain oils for a variety of complaints.

Specifically, aromatherapy may benefit:

Respiratory disorders such as bronchitis. In one study, twelve patients with chronic bronchitis were treated with aromatherapy through topical application over a period of five hours. Aromatherapy was found to have a positive effect on clearing mucous from the airways during the first hour of treatment but none thereafter. (7)

Anxiety and panic. Study results are conflicting concerning the benefit of aromatherapy for anxiety. A recent study of aromatherapy using lavender and rosemary oils indicated these scents reduced stress in graduate nursing students who were about to take tests. (8) However, in a later study, lavender aromatherapy was tested on 96 healthy undergraduate women to determine if it reduced their stress levels. The results indicated that the expectation of being relaxed may have influenced the results. (9)

Alzheimer's Disease (AD). The effect of aromatherapy was studied in 17 elderly patients with Alzheimer's over a period of 84 days. Essential oils of rosemary and lemon were used in the morning, followed by lavender and orange in the evening. All of the patients showed improvement in cognitive function with no side effects from the aromatherapy. More studies of larger size are needed to confirm these results. (10)

For mental disorders, a significant number of controlled studies exist regarding aromatherapy and dementia but very few for other mental disorders. Small, open-label studies exist that may eventually prompt more controlled studies. Currently, aromatherapy is used as an adjunct treatment in mental disorders such as schizophrenia and depression as well as sleep disorders such as insomnia and sleep apnea, which accompany many mental disorders. (11) The essential oil from St. John's wort is being used to treat depression in HIV/AIDS patients. The essential oil contains quercetin, which has exhibited anti-HIV properties in laboratory studies and may be useful in future antiviral research. (12)

Chronic pain. Aromatherapy is used worldwide to manage many disorders including chronic pain, but there are few studies to support its benefit. (11) It is included as part of a multifaceted approach to managing chronic pain in children. (13)

Menopause. In one study, fifteen menopausal women received a 30-minute aromatherapy session in a hospital setting. The women received guidance for home care and returned one month later for a second aromatherapy session. The study showed significantly lowered symptoms after this treatment. (14) In another study, 25 menopausal women were given aromatherapy massage of the arms, back, and abdomen with essential oils of lavender, rose, geranium, and jasmine once a week for eight weeks. The women reported reduced symptoms including hot flashes, pain, and depression. However, it was unclear if the benefits were from the aromatherapy, the massage, or the combination of the two. (15)

Menstrual cramps (dysmenorrhea). Aromatherapy may be helpful in alleviating severe menstrual cramps, or dysmenorrhea. In one study, 67 women were divided into three groups: control, placebo, and treatment. The control group was given no treatment, the placebo group received abdominal massage with almond oil, and the treatment group received aromatherapy abdominal massage with lavender, sage, and rose in almond oil. At the end of the study, the aromatherapy group reported significantly lower menstrual cramps than the other two groups. Aromatherapy may be included in a regimen for reducing the severity of menstrual cramps. (16)

Bacterial infections. In laboratory studies, essential oils such as lemongrass and eucalyptus exhibited antifungal and antimicrobial activity against infections such as ringworm, Escherichia coli (E.coli), and Bacillus subtilis (a bacteria found in soil). Results from a 2001 study indicated essential oils exhibited antimicrobial activity on a chronic case of methicillin resistant Staphylococcus aureus (MRSA). In this study, a patient developed chronic MRSA after an open leg fracture. Long-term treatment with oral and intravenous antibiotics proved unsuccessful and amputation was being considered. An opening was made in the patient’s leg, cleaned with a saline solution, then packed with calcium sulfate pellets impregnated with lemongrass, eucalyptus, tea tree, clove, and thyme in ethyl alcohol. One milliliter of this solution was administered each day via catheter. After three months of treatment, the wound had healed and the MRSA was gone. In another study, a tea tree oil combination was found to be more effective against MRSA than a control of 3% mupirocin nasal ointment and triclosan. (17) Another aromatic plant whose essential oil shows promise as an anti-HIV agent is the Samoan herb Homalanthus nutans (H. nutans). Prostratin, the active ingredient in this plant, was so powerful against HIV in laboratory studies that in 1992 the National Cancer Institute (NCI) immediately patented it for future research. (17,18)

Post-operative pain. Aromatherapy may be of benefit in the management of pain after surgery by permitting a reduction in the dosage of traditional analgesics and reducing dose-related side effects. In a 2007 study, 54 patients undergoing bariatric gastric-banding surgery were divided into two groups. The study group was given oxygen masks with lavender oil to inhale post-operatively while the placebo group was given baby oil. The aromatherapy group required less morphine and other analgesics than the placebo group. More studies are needed to determine possible side effects and application to other types of surgeries. (19)

The National Association for Holistic Aromatherapy gives a top ten list of essential oils and their uses. Among their recommendations are:

  • Peppermint oil for relieving nausea and aiding digestion. Eucalyptus oil for relieving congestion and muscle tension.

  • Ylang Ylang for reducing stress and muscle tension.

  • Lavender oil for skin care and for reducing stress.

  • Rosemary for improving mood and stimulating the digestive system. (2)

While aromatherapy is generally quite safe, it is important to keep in mind that it is a complementary therapy and not a substitute for conventional medical care.

How To Choose a Practitioner

Although aromatherapy is simple and safe enough to be done at home, seeing a trained practitioner may help with choosing the right essential oils for the desired effects.

There is no licensing of aromatherapists in the United States, although Great Britain and other European countries do require it. In the U.S., the American Holistic Nurses Association has approved certification through a course offered by R.J. Buckle Associates for licensed health care practitioners: Clinical Aromatherapy for Health Professionals (CCAP) includes a certification exam as well as a research project. (20) Other courses may be available. If a practitioner indicates that certification has been obtained, be sure to check the source of training. Also consider working with (or getting a referral from) a massage therapist, chiropractor, or other practitioner who has had some clinical training.

Cautions

  • Essential oils should never be taken internally.

  • To prevent allergic reactions, first test any essential oil on a small patch of clean skin. Mix a drop of the essential oil with a few drops of unscented carrier oil, such as safflower oil. Place a bandage over the area and wait 24 hours. If no irritation occurs, the oil can be applied. If a rash develops, try another essential oil.

  • If sensitivity to an oil occurs, stop using it.

  • Anyone with asthma should consult their doctor before using aromatherapy, because certain aromatherapy oils can trigger bronchial spasms.

  • Unless you're very familiar with aromatherapy, it's best to avoid using it during pregnancy. The essential oils of basil, thyme, clary sage, calamus, mugwort, pennyroyal, sage, rosemary, juniper, and wintergreen can all harm the fetus or induce miscarriage if taken internally. Since a certain amount of oil is absorbed through the skin, external application may also be risky.

References

1. Aromaweb History of Aromatherapy. Website available at http://www.aromaweb.com/articles/history.asp. Accessed July 17, 2010.
2. National Association for Holistic Aromatherapy. Website available at http://www.naha.org. Accessed July 17, 2010.
3. Angier N, The Nose, an Emotional Time Machine, New York Times, August 5, 2008, p.F1.
4. Redd WH, Manne SL, Peters B, Jacobsen PB, Schmidt H. Fragrance administration to reduce anxiety during MR imaging. J Magn Reson Imaging. 1994 Jul-Aug;4(4):623-6.
5. Stevensen CJ. The psychophysiological effects of aromatherapy massage following cardiac surgery. Complement Ther Med. 1994;2:27-5.
6. Hay IC, Jamieson M, Ormerod AD. Randomized trial of aromatherapy. Successful treatment for alopecia areata. Arch Dermatol. 1998 Nov;134(11):1349-52.
7. Hasani A, Pavia D, Toms N, Dilworth P, Agnew JE. Effect of aromatics on lung mucociliary clearance in patients with chronic airways obstruction. J Altern Complement Med. 2003 Apr;9(2):243-9.
8. McCaffrey R, Thomas DJ, Kinzelman AO, The effects of lavender and rosemary essential oils on test-taking anxiety among graduate nursing students. Holist Nurs Pract. 2009 Mar-Apr;23(2):88-93.
9. Howard S, Hughes BM. Expectancies, not aroma, explain impact of lavender aromatherapy on psychophysiological indices of relaxation in young healthy women. Br J Health Psychol. 2008 Nov;13(Pt 4):603-17. Epub 2007 Sep 7.
10. Jimbo D, Kimura Y, Taniguchi M, Inoue M, Urakami K. Effect of aromatherapy on patients with Alzheimer's disease. Psychogeriatrics. 2009 Dec;9(4):173-9.
11. Perry N, Perry E. Aromatherapy in the management of psychiatric disorders: clinical and neuropharmacological perspectives. CNS Drugs. 2006;20(4):257-80.
12. Buckle J. Clinical aromatherapy and AIDS. J Assoc Nurses AIDS Care. 2002 May-Jun;13(3):81-99.
13. Chambliss CR, Heggen J, Copelan DN, Pettignano R. The assessment and management of chronic pain in children. Paediatr Drugs. 2002;4(11):737-46.
14. Murakami S, Shirota T, Hayashi S, Ishizuka B. Aromatherapy for outpatients with menopausal symptoms in obstetrics and gynecology. J Altern Complement Med. 2005 Jun;11(3):491-4.
15. Hur MH, Yang YS, Lee MS. Aromatherapy massage affects menopausal symptoms in korean climacteric women: a pilot-controlled clinical trial. Evid Based Complement Alternat Med. 2008 Sep;5(3):325-8.
16. Han SH, Hur MH, Buckle J, Choi J, Lee MS. Effect of aromatherapy on symptoms of dysmenorrhea in college students: A randomized placebo-controlled clinical trial. J Altern Complement Med. 2006 Jul-Aug;12(6):535-41.
17. Buckle J. Clinical aromatherapy and AIDS. J Assoc Nurses AIDS Care. 2002 May-Jun;13(3):81-99.
18. Gustafson, K.R., Cardellina, J.H., II, McMahon, J.B., Gulakowski, R.J., Ishitoya, J., Szallasi, Z., Lewin, N.E., Blumberg, P.M., Weislow, O.S., Beutler, J.A., Buckheit, R.W., Cragg, G.M., Cox, P.A., Bader, J.P., Boyd, M.R. J. Med. Chem. 35: 1978-1986, 1992. A nonpromoting phorbol from the Samoan medicinal plant Homalanthus nutans inhibits cell killing by HIV-1. J Med Chem. 1992 May 29;35(11):1978-86.
19. Kim JT, Ren CJ, Fielding GA, Pitti A, Kasumi T, Wajda M, Lebovits A, Bekker A. Treatment with lavender aromatherapy in the post-anesthesia care unit reduces opioid requirements of morbidly obese patients undergoing laparoscopic adjustable gastric banding. Obes Surg. 2007 Jul;17(7):920-5.
20. RJ Buckle Associates, LLC. Website available at http://www.rjbuckle.com. Accessed July 24, 2010

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Alzheimer's Disease (AD)

   

One small study showed improvement in cogn


Date Published: 04/19/2005
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